Provider Demographics
NPI:1487042198
Name:MINA HABIBIAN DMD PHD DENTAL CORPORATION
Entity Type:Organization
Organization Name:MINA HABIBIAN DMD PHD DENTAL CORPORATION
Other - Org Name:SABRE SPRIGNS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINA
Authorized Official - Middle Name:N
Authorized Official - Last Name:HABIBIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:858-496-8611
Mailing Address - Street 1:11385 POWAY RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-5600
Mailing Address - Country:US
Mailing Address - Phone:858-496-8611
Mailing Address - Fax:
Practice Address - Street 1:11385 POWAY RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-5600
Practice Address - Country:US
Practice Address - Phone:858-496-8611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-04
Last Update Date:2015-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48280261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center